Browsing by Subject "HIV testing"

Background: HIV-related stigma is a barrier to the success of programs targeting the prevention and treatment of HIV. In Sub Saharan Africa, where the HIV epidemic is concentrated, men play a critical role in defining and shaping social constructs, including HIV stigma. This study aimed to describe HIV stigmatizing attitudes, to identify factors associated with stigmatizing attitudes, and to explore the broader context of HIV stigmatizing attitudes among men in Tanzania. Methods: This mixed-method study recruited 489 men from antenatal clinics of two public primary health care facilities in Moshi municipality, Tanzania. Participants completed a structured survey using audio computer assisted self-interviewing technology; a subset of 16 men completed in-depth interviews. HIV stigmatizing attitudes were examined using a modified version of the Personal Stigma Scale, and logistic regression models identified associating factors. Qualitative data were analyzed using applied thematic analysis. Results: The majority (72%, n=356) of participants endorsed at least one of the stigmatizing attitudes; the most common attitude endorsed was a perception of HIV is a punishment for bad behavior (37%, n=180). In a multivariable logistic analysis, men with only primary education were twice as likely as those with secondary or high to hold high stigmatizing attitudes (OR=2.05, 95% CI 1.39, 3.04). Qualitative analysis revealed that masculine identity intensified the vulnerability of men towards HIV stigma, while HIV testing experience spurred behavior change to reduce HIV risk behavior. Conclusions: HIV stigmatizing attitudes are prevalent among men. Comprehensive community-based stigma reduction programs to provide a supportive environment for men are crucial to increase uptake of HIV testing and treatment services.

Background: In 2016, 36.7 million people globally were living with HIV and approximately 70% knew their status. Novel HIV testing methods and strategies are needed to reach the first “90-90-90” target by 2020; that is 90% of people living with HIV know their status. Children and adolescents face additional barriers to HIV testing that stem from gaps in provider-initiated testing and counselling (PITC), parents’ concerns related to stigma and discrimination, and beliefs that children living with HIV cannot survive to adolescence. PITC barriers and the stigma and discrimination parents’ may face when seeking HIV testing and counselling (HTC) for their children could be reduced through a novel HIV testing strategy, which includes oral fluid tests (OFTs) and parents performing oral fluid HIV self-tests (O-HIVST) on their children. Therefore, the study aims of this thesis were: 1) to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of an OFT for HIV in children aged 2-18 using the standard point of care rapid diagnostic test (RDT) as a reference, 2) to explore parents’/guardians’ and older adolescent’s knowledge of, and attitudes about, OFTs and O-HIVST, 3) to explore parents’/guardians’ and older adolescent’s preferences when undergoing O-HIVST. No studies to our knowledge have examined the diagnostic accuracy of OFTs in children or the facilitators of O-HIVST performed by a parent or guardian on their children.

Methods: We conducted the study in two large urban hospitals in Harare, Zimbabwe. The sample included children and adolescents aged 2-18 whose HIV status was unknown. We performed an OFT, followed by a finger-prick RDT to validate the OFT results. In addition, we conducted in-depth interviews (IDIs) with parents/guardians of children aged 2-15 and older adolescents aged 16-18. Quantitative analysis included tabulating descriptive statistics and calculating sensitivity, specificity, PPV, and NPV of the OraQuick ADVANCE® Rapid HIV-1/2 Antibody Test. Thematic qualitative analysis was conducted on the IDIs.

Results: Preliminary sensitivity results of the OFT showed high sensitivity at 100% (95% CI 83.89, 100.00) and high specificity at 99.77% (95% CI 99.17, 99.97) compared to the finger-prick RDT. In addition, PPV was 91.30% (95% CI 71.96, 98.93), and NPV was 100% (95% CI 99.57, 100.00). Qualitative findings showed low knowledge of OFTs and O-HIVST among parents and adolescents. However, participants reported favorable attitudes towards performing O-HIVST on themselves and their children and also reported a preference for a wide range of uptake mechanisms when asked about O-HIVST. Participants expressed concern about O-HIVST but felt that counselling could reduce unfavorable reactions to positive O-HIVST results.

Conclusions: The preliminary analysis confirmed the OFT has high sensitivity, but a larger sample size is needed to obtain a more accurate estimate of OFT sensitivity. If future findings confirm our preliminary results, we recommend OFTs as a method to increase HIV testing and uptake among children. Participants’ low knowledge of OFTs and O-HIVST indicate sensitization is needed before scale up of this new method. We also recommend O-HIVST implementation include a variety of strategies to increase O-HIVST uptake among children and adolescents who may face barriers to traditional HTC.

Since 2005, China Global Fund AIDS programs have considered men who have sex with men (MSM) an "at-risk population" with priority and significance to receiving HIV testing. Community-based organizations (CBOs) have been involved in implementing the intervention programs, including free HIV testing, to MSM. This thesis explores the consequences of HIV testing as an intervention on local MSM's perceptions and relationships. Participant observation, in-depth interview and textual analysis were conducted during fieldwork research at a local CBO. It is argued that the complexities of everyday practices of public health programs at the community-level need to be emphasized in supervision. The success of China's HIV/AIDS intervention strategies is at stake: free HIV testing needs to be implemented as a benefit to testing receivers' health instead of as an obligation or commodity. In everyday practice, HIV testing is full of complexities and via HIV testing, interrelations among CDC system, local CBOs, and local MSM are reproduced and images and perceptions of free HIV testing are reconstructed. Moreover, receiving HIV testing was integrated into a new moral discourse of how to be a "good" MSM. It is recommended for local CBOs to cultivate their professionalization, and be aware of new stigmatization produced by free HIV testing. Meanwhile, a transition of local governmentality and supervision technologies is needed.